Background: Infants with congenital heart diseases undergoing open-hear surgery require mechanical ventilation. Failed extubation (FE) is statistically associated with prolonged mechanical ventilation. This study was undertaken to investigate the risk factors of FE after cardiac surgery in infants.

Mothods: A total of 227 infants of less than 1 year old who had undergone congenital heart surgery (CHS) were enrolled in this study. Logistic regression analysis was used to assess the risk factors of FE. Odds ratio was used to assess the degree of relationship between FE and risk factors.

Results: Out of the 227 infants undergoing CHS, 30 (13.22%) failed at the extubation. Risk factors for failed extubation included postoperative duration of mechanical ventilation (EOR=12.0; 95%CI=4.04-35.71; P=0.009), postoperative pneumonia (EOR=5.33, 95%CI=1.81-15.68, P=0.002), and preoperative pulmonary hypertension (EOR=2.80, 95%CI=1.21-10.45, P=0.041). Postoperative pneumonia and preoperative pulmonary hypertension were the 2 independent risk factors for FE (P<0.05).

Conclusions: Postoperative pneumonia and preoperative pulmonary hypertension are the major risk factors for FE after CHS in infants. The prevention and treatment of postoperative pneumonia and pulmonary hypertensive crises are beneficial to the successful extubation.